中国普外基础与临床杂志

中国普外基础与临床杂志

消化道恶性肿瘤患者非计划再手术危险因素及预后转归的相关分析

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目的 探讨消化道恶性肿瘤患者非计划再手术发生和预后转归的相关因素。 方法 回顾性分析 2014 年 1 月至 2017 年 12 月期间上海交通大学医学院附属第九人民医院北部普外科消化道恶性肿瘤发生非计划再手术患者的临床资料,每例再手术患者以 1∶3 的比例为其选择病例作为对照研究。收集患者的基本资料、术前、术中及术后相关资料,分析影响消化道恶性肿瘤患者非计划再手术发生和术后死亡的相关因素。 结果 2014 年 1 月至 2017 年 12 月期间共开展消化道恶性肿瘤手术 588 例,非计划再手术患者 33 例(5.6%),8 例(24.2%)再手术后死亡。患者术前有慢性基础疾病、既往腹部手术史、ASA 分级 3~4 级、术前存在贫血、初次手术时间≥4 h 和术中出血量≥400 mL 患者以及术后并发症发生率与非计划再手术有关(P<0.050),且其中有基础疾病、有腹部手术史、有术前贫血、手术时间≥4 h 及术中出血量≥400 mL 是影响非计划再手术的独立危险因素(P<0.050);患者初次手术前有基础疾病、非计划再手术前血红蛋白<90 g/L 以及非计划再手术中出血量≥400 mL 与非计划再手术患者术后死亡有关(P<0.050),且其中患有基础疾病、非计划再手术前血红蛋白<90 g/L 及非计划再手术中出血≥400 mL 是非计划再手术患者术后死亡的独立危险因素(P<0.050)。 结论 通过对消化道恶性肿瘤患者非计划再手术发生的独立危险因素相关因素的有效干预可以降低日后临床工作中消化道肿瘤非计划再手术发生率并改善预后。

Objective To explore risk factors and prognosis of unplanned reoperation in patients with malignant tumors of digestive tract. Methods The clinical data of patients with malignant tumors of digestive tract underwent unplanned reoperation who treated in the Department of General Surgery, the Northern District of the Shanghai Ninth People’s Hospital from January 2014 to December 2017 were retrospectively collected, and each operation was matched in a ratio of 1:3 as a case-conontrol study object. The risk factors and prognosis of unplanned reoperation were analyzed by the basic information, surgical related informations, and postoperative relevant informations. Results There were 33 cases of unplanned reoperation in the 588 patients with malignant tumors of digestive tract treated surgically, 8 cases died after the unplanned reoperation. The analysis results showed that the basic diseases, previous abdominal surgery, preoperative anemia, the first operative time >4 h and intraoperative blood loss≥400 mL were the independent risk factors of the unplanned reoperations (P<0.05), the basic diseases, preoperative hemoglobin <90 g/L and intraoperative blood loss≥400 mL were the independent factors of death for patients with unplanned reoperation ( P<0.05). Conclusions Effective intervention on independent risk factors associated with unplanned reoperation in patients with digestive tract malignant tumors can reduce incidence of unplanned reoperation in future and improve prognosis.

关键词: 消化道恶性肿瘤; 非计划再手术; 危险因素

Key words: malignant tumors of digestive tract; unplanned reoperation; risk factors

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